Provider Demographics
NPI:1861680183
Name:ULTRALIFE SENIOR CARE PLANNING COUNCIL
Entity Type:Organization
Organization Name:ULTRALIFE SENIOR CARE PLANNING COUNCIL
Other - Org Name:ULTRALIFE ADULT DAY HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYBELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-307-1113
Mailing Address - Street 1:101 S NEW AVE
Mailing Address - Street 2:1022 EAST GARVEY AVE
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-3032
Mailing Address - Country:US
Mailing Address - Phone:626-307-8806
Mailing Address - Fax:606-307-8808
Practice Address - Street 1:101 S NEW AVE
Practice Address - Street 2:1022 EAST GARVEY AVE
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-3032
Practice Address - Country:US
Practice Address - Phone:626-307-8806
Practice Address - Fax:606-307-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care